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In February 2005, Australian physician Albert Cutter showcased his 'Do Not Resuscitate' tattoo. Over recent years, medical tattoos have gained popularity, though DNR tattoos present challenges for doctors in emergency scenarios. Photo credit: Fairfax Media via Getty ImagesTattoos often demand interpretation. Actor Melvin Van Peebles famously has a neck tattoo reading "Cut on the dotted line — if you can," while a lower back tattoo saying "Insert coins in slot" remains a popular internet meme. Clearly, neither should be taken at face value.
When a 70-year-old unconscious man arrived at a Miami hospital with a "Do Not Resuscitate" tattoo on his chest, ICU doctors faced a dilemma. As outlined in a letter to the New England Journal of Medicine, the tattoo included the man’s presumed signature, but without identification or family present, it didn’t constitute a legally binding DNR directive.
The more conventional methods for expressing do not resuscitate wishes: a hospital bracelet and a formal document
Enigmangel/iStock/ThinkstockMedical tattoos have been around for a while and have sparked debates in the past. According to USA Today, the use of medical tattoos to inform doctors about conditions like diabetes was already growing in 2014. While some physicians appreciate the practicality of medical tattoos, the majority believe that a standardized medical ID bracelet remains the superior option. This is because, although a tattoo is permanent, its readability and clarity can be problematic, particularly in urgent medical situations.
As expected, Doctors Holt, Sarmento, Kett, and Goodman from the University of Miami noted in their letter that the DNR tattoo "caused more confusion than clarity." Was it a legally binding request concerning end-of-life care? Did it genuinely reflect a heartfelt desire, or was it more akin to "Cut on the dotted line?"
Initially, the doctors chose not to respect the DNR tattoo and proceeded with standard life-saving measures, including intravenous fluid resuscitation. Troubled by the apparent finality of the tattoo, they sought advice from ethics specialist Dr. Kenneth W. Goodman, who recommended they honor the tattoo and formalize a DNR order.
Thankfully, a social worker secured the patient’s Florida Department of Health "out-of-hospital" DNR order, providing legal backing for the tattoo. This ensured the doctors didn’t have to rely solely on the tattoo. The patient passed away later that night "without receiving cardiopulmonary resuscitation or advanced airway interventions."
The letter to the New England Journal of Medicine "neither endorses nor condemns the use of tattoos to communicate end-of-life wishes when the individual is incapacitated." However, until medical alert tattoos become a standardized and regulated practice, traditional pen-and-paper DNR forms remain the safer choice.
Medically assisted suicide involves a doctor prescribing lethal medication for a patient to self-administer. In contrast, euthanasia occurs when a person, usually a physician, directly administers a lethal dose to the patient.
